YJHM: Nurdeen Deuraseh and Hanisah Yaacob, "Issues on Medical Treatment in Islam"

In this paper, two issues related to medical treatment will be discussed. The first is the Muslim belief about seeking medical treatment. In other words, is it better to seek medical treatment or otherwise? The second is to discuss the examination of a patient by a member of the opposite sex as stated in Islamic medical law. The latter has been discussed widely in books of Ahadith and Islamic jurisprudence including a chapter in the Sahih of Imam Bukhari entitled Bab Hal Yudawi al-Rajl al-Mar’ah wa al-Mar’ah al-Rajl ("May a man treat a woman or a woman treat a man?").[1]

In any attempt to discuss medical treatment in Islamic history, we have to answer before anything else a central question namely ““hal al-tadawi afdal min tarkuhu: Is seeking medical treatment better than abandonment? In the middle of third century after hijrah and even after, this issue became one of the serious debates and has been discussed widely in Islamic legal literature. In this regard, there are two different opinions of Muslims in answering the question. These two opinions are based on the ahadith reported by Imam Bukhari (194-256/ 810-870) in bab ma anzala Allah da’ illa anzala lahu shifa’ ("There is no disease that Allah has created except that He also has created its treatment"). The first opinion agrees with Imam Bukhari’s idea that it is better to seek medical treatment. On the other hand, some Muslims, especially Sufis, believe that tark al-tadawi (leaving of seeking medical treatment) is better as a sign of piousness.

The first school of thought, which represents the opinion of Imam Bukhari, realized the importance of the art of medicine as a means to preserve health and restore it, if one falls into illness, into the normal condition. Following the idea of Imam Bukhari, the majority of the Sunni legal schools accept the use of medicines because it does not deny the belief of God’s destiny (al-tadawi la yunafi al-tawakkal).[2] For this reason, Ibn Hajr (773–852/1372-1449), the author of Fath al-Bari, advised a patient to seek relief and healing from any physical or mental ailment by means of medical assistance and treatment; and not only by putting one’s trust in God’s power and mercy. This interpretation was essentially a distraction from the ahadith, although in many cases the Prophet (s.a.w) did not provide specific drugs for certain treatment. However, we are responsible to find its cure because Allah (s.a.w) mercifully provides cures for all illnesses except death and old age. Imam Bukhari reported the hadith of the Prophet (s.a.w): “for every disease there is a remedy, and when the remedy is made apparent, then the disease is cured by the permission of Allah, the Almighty.” Connecting to this hadith, Imam Bukhari reported that Abu Hurayrah narrated the hadith of the Prophet: “Allah has not created any disease without also creating a medicine or a remedy for it (ma anzala Allah da’ illa anzala lahu shifa’).”[3]

The word al-inzal, (literally, "send down"), according to Ibn Ahmad al-Ayni, indicates that disease was sent down by Allah (s.w.t) through the angel (inzal al-mala’ikah al-muwakkilin bi mubasharah makhluqat al-ard min al-da’ wa al-dawa’)[4] and not by supernatural powers, a spirit, a ghost, either because the patient has broken a taboo or otherwise offended a spirit, or simply because he has fallen a victim to the ghost of an unreconciled dead or to the malice of a demon. Even though disease was sent down by Allah (s.w.t) through angels, patients still have a strong desire to know the meaning of their being sick. Why am I suffering? Why am I sick? Why am I plagued with a gastric ulcer that will kill me? What have I done to deserve such a fate? These are questions the physician today may hear all the time and everywhere. For those who read the hadith “Allah has not created any disease without also creating a medicine or a remedy” ask the question if God is the only one who cures the diseases, so why does God send the disease? The commentators of Sahih Bukhari agreed that God sent down illnesses but they failed to give a detailed explanation why God sent them to people.

They did, however, express some opinions on the matter while discussing various illnesses. In the time while some people believe that an individual is sick as a punishment for having sinned, for having committed an offense against the law of God, especially when a individual is stricken in the organ with which he has sinned. However, Muslims believe that illnesses were not God’s punishment to the believer but to scrutinize him, to test whether he (the patient) satisfies God’s bounty or otherwise. This means that the purpose of sending the disease is to remind the believer that he is a servant who should supplicate humbly to God, the Creator of all Universes. As the servant, he has to prostrate himself in front of Him, and seek refuge in Him. If the believer has success in fighting disease, then the disease, in this case, is considered as the means to increase his Iman (faith). Otherwise, it may destroy man’s life in this world and the hereafter. They quoted the hadith of the Prophet who said, "Whatever misfortunes a true believer may have-fatigue, grief, melancholy or worry - are used to redeem his sins."

Although the above evidence seemingly represents Islamic medical teaching, but there were Muslims who doubt about the permissibility of the use of medicines. It is very regrettable that some of them were of opinions that medical treatment is permissible, but its abandonment is better. They understood that the use of medicine is an act incompatible with tawakkal (belief of God’s destiny). They argued that the preference to use medicine was an expression of one’s distrust in Allah (s.w.t). In their opinion, it was only Allah (s.w.t) who directly caused health and illness, and therefore, He alone cure disease. It is not surprising that Ahmad b. Hanbal (d. 240/855), for example, was reported to have said that medical treatment is permissible, but its abandonment is better. Similarly, Rabi‘ah al-`Adawiyyah, the well-known woman Sufis, does not regard treatment disease as essentially demand of Islam. In one story, when Rabi‘ah al-`Adawiyyah was asked to pray to Allah (s.w.t) to ease her suffering, she replied: "Do you not know who has willed my suffering? Is it not Allah? If you know this, then why do you ask me to pray for what contradicts His will."[5]

In the middle of third century after hijrah and even after, the debate over examination of patient by member of opposite sex became one of the serious issues and has been discussed widely in Islamic legal literature as well as in the books of ahadith. In this regard, there are two different opinions of Muslims in answering the question. The first opinion does not allow examination of a patient by a member of the opposite sex. On the other hand, the majority of Muslims, are in favor of allowing examination of a patient by a member of the opposite sex.

Some Muslim scholars oppose permissibility of examination of a patient by a member of the opposite sex. Their strongest argument relies heavily on the verse of the Quran in surah al-Nur, verse no. 31 said: “And say to the believing women that they should lower their gaze and guard their modesty; that they should not display/reveal their adornments except what appear thereof; that they should draw their veils over their bosoms and not display their beauty except to their husbands, their fathers, their husbands’ fathers, their sons, their husbands’ son, their brothers or their brothers’son, or their sisters’s sons…and that they should not strike their feet in order to draw attention to their hidden ornaments. And o ye Believers! Turn ye all together towards Allah in repentance that ye May be successful.” (al-Nur(24): 31). Based on this verse, some Muslims understood that Islamic law has legislated a man to see and touch a woman only after marriage. The strangers are prohibited from looking at any part of her except her face and most probably her hands.

There are many religious scholars who are more tolerant on the issue of examination of patient by member of opposite sex. In response to the opposing view, Imam Bukhari entitled one of his collections of ahadith Bab Hal Yudawi al-Rajl al-Mar’ah wa al-Mar’ah al-Rajl ("May a man treat a woman or a woman treat a man?"). By using the word yudawi (medical treatment) and not yukhdimu (to serve), it clearly indicated a permissibility of examination of a patient by a member of the opposite sex and it is a response to Muslims who believed that Islamic law has legislated a man to see and touch a woman only after marriage and the strangers are prohibited from looking at any part of her except her face and most probably her hands.

In the mentioned chapter, Imam Bukhari reported the hadith which was narrated by Rubai bint Mu'adh bin `Afra’ who said: “Kunna naghzu ma`a Rasulullah (s.a.w) nasqi al-qawm wa nakhdimuhum, wa naruddu al-qatla wa al-jurha ila al-madinah: We used to go for Military expeditions along with Allah’s Apostle and provide the people with water, serve them and bring the dead and the wounded back to Medina.”[6] We found that Muslim army under the leadership of Prophet (s.a.w) consisted of medical Muslim ladies who had special training in the therapy and nursing. In this regard, Ibn Hajr elucidated that the word nakhdimuhum (serving them), as mentioned in the hadith, gives general meaning, which also includes al-mudawat (treatment of disease).[7] Since the permissibility of medical serving from the opposite sex is dictated by the Prophet (s.a.w) in general sense, thus, Ibn Hajr concluded that its permissibility is applied and included treatments of disease regardless a patient is muhran or non muhram.[8]

In the light of the above evidence, Ahmad b. Hanbal, the founder of Madhhab Hanbali, was of the opinion that the permissibility of examination a patient by member of opposite should be included to all patients regardless muhram or not. It is permissible (halal) for a physician to examine a woman, even though, she is not related, whenever it is necessary to do so, and including even her private parts. Similarly, it is permissible for woman to look at the private parts of a man in case of necessity. All of these arguments clearly show that it is permissible for a man to treat a woman to whom he is not related and to see her private parts in cases of illness. In the same way, if a man dies among women or a woman dies among men, the woman are permitted to wash the dead body of the man, and then that of the woman. This permissible was, strictly speaking, allowed in the darurah. By this concept, the Muslim may help to provide some ideas for protection against diseases and to explore some of the avenues of Islamic law that can be utilized towards health objective.[9] Of course, according to the shari‘ah, priority should be given to fighting a harm, which threatens safety of the five essential values (al-darurah al-khamsah): faith, life, intellect, property and lineage. All of these values are the basis to preserve a human’s physical and spiritual health. In studying these goals, one will find that two of the essential values, religion and property, are strongly concerned with man’s health because there is no keeping of religion, nor of property without being a strong, good and healthy Muslim.[10]

In addition, Muslims argue that although the service of women as mentioned in the ahadith limited to the serving (yakhdimu) and nursing but in reality, however, as far as Islamic medical treatment is concerned, there is no difference between nursing and treatment of disease in the view of Muslim scholars. While talking the practical aspect of this permissibility, we were told that there were indeed quite excellent and outstanding examples of Muslim women in regard to nursing profession in the time of Prophet (s.a.w). Their skills and performances in health care were based on voluntary services and dedications. They practically showed great zeal and benevolence services. All these had been rendered in such professional manners that exhibited at the most skill, genuine faith and the deepest sympathy and tender loving care of hearth and spirit. Their actions were characterized with commendable performances of good deeds. These noble women reflected excellent responsiveness to duty and dedicated services because they indeed rendered unusual example of kindness and unselfish care the sick and the wounded, that had unsurpassed contributions in practical nursing. For example, the Prophet’s wife, A`ishah (r.a), had been recognized as having extensive medical knowledge in her time. When she was asked how she had got it, she answered: “I used to listen to people describing cures to each other and I memorized what they said.”[11] Similarly, Umayyah bt. Qays Abi al-Salt al-Ghaffariyyah, who had been converted to the Islamic faith and swear loyalty to the Prophet (s.a.w), was among the truly dedicated women in nursing profession in several battles. Surprisingly enough, we were told that she and several women from the same tribe came to Prophet (s.a.w) requested from him to join the battle to take care for the sick, just before the Khaybar battle: “We would like to join the battle to care for sick and wounded and do what we can to help the Islamic cause?.” It probably because of this religious spirit and responsibility, Ku`aybah Bt. Sa`d al-Aslamiyyah, a virtuous and devout woman, had decided to devote her life in caring the sick and the wounded. It was said that among those who were treated by her, was Sad B. Mu`adh when struck by an arrow at the battle of Khandaq. After getting the credit in treating the wounded in the battle of Khandaq, she participated the battle of Khaybar, where she served and practiced unselfishly in helping and caring for the sick and the injured. Such religious spirit encouraged Nusaybah bt. Ka`b Bt. Umar B. Awf al-Ansariyyah known as Umm Umarah to become a nursing in the time of the prophet (s.a.w). As a religious woman with dignity and great faith and dedication, she also showed generous spirit, self-reliance and having good deeds to her credit. She attended and served diligently during the `Aqabah combat. She also joined the battle of ‘Uhud offering water to the fighters and caring for the sick and the wounded.[12]

The above analysis has given a clear picture on the validity of the examination of patient by member of opposite sex in the eyes of the Islamic law especially if one finds it advantageous. However, on the occasion that a woman patient desires to be examined by a woman doctor, we should satisfy her wish not because it is religiously forbidden to be examined by a man doctor but because we owe it to our patients to respect their personal beliefs and cater for their psychological comfort.

[1] To give an accurate explanation and interpretation of ahadith in Sahih Bukhari, I will consult many important commentaries of Sahih Bukhari most natably Umdah al-Qari Sharh Sahih Bukhari by Badr al-Din `Ayni (762-855/1361-1452), 25 vols. (Beirut: Dar Ihya’ al-turath al-`Arabi, n.d); Fath al-Bari fi Sharh Sahih Bukhari by Ibn Hajr al-`Asqalani (773–852/1372-1449), 13 vols. (Beirut: Dar al-kutub al-`ilmiyyah, 1989).

[3] Sahih Bukhari, Kitab al-Tibb, Bab Ma anzala Allah da’ illa anzala lahu shifa’.

[4] Al-`Ayni, Umdah al-Qari, 21: 229-30.

[5] Fazlur Rahman, Health and Medicine in the Islamic Tradition (New York: Crossroad Publishing Company, 1989; repr., Kuala Lumpur: S. Abdul Majeed & Co, 1993), 49.

[6] Sahih Bukhari, Bab Hal Yudawi al-Rajl al-Mar’ah wa al-Mar’ah al-Rajl.

[7] Ibn Hajr, Fath al-Bari,10: 167.

[8] Literally, darurah is derived from the root darr means: to face adversity. The works of jurists often referred to situations of necessary when one is faced with fighting and preventing a darar. Also, darurah is defined as a situation, which presents fear of destruction, substantial harm to one of the essential values, faith, intellect, property and lineage, involving oneself or another human being. The fear is perceived either with certainty or with a strong probability, that destruction or injury will occur, immediately or later, if measures are not taken to prevent it. (See, Abd. Wahab Ibrahim Abu Sulayman, Fiqh al-Darrrah wa Tatbiqatuh al-Mu‘asarah (Jeddah: al-Ma‘had al-Islami li al-Buhuth wa al-Tadrib, 1414/1993), 65).

[9] Al-Nasimi, Tibb al-Nabawi wa `ilm al-hadith, 2: 285-7; Enclyclopaedia of Islam, new ed., “Darrra,” by Y. Linant De Bellefond; Mohammad Muslehuddin, “Islamic Jurisprudence and the Rule of Necessity and Need,” Islamic Studies 11, no.1 (March 1973), 37-52.

[10] In the Holy Qur’an, Allah (s.w.t) says: “But if one is compelled by necessity, neither craving (it) nor transgressing, there no sin on him indeed, Allah is forgiving, merciful.”( al-Baqarah: 173) “Allah desire ease for you, He desireth not hardship for you.” (surah al-Baqarah (2): 185) “He hath chosen you and hath not laid upon you religion any hardship.” (al-Hajj: 78), see also, al-Ma’idah (5): 6; al-Nisa’(4): 28, al-An-‘am (6): 119, 145; Na^l (16): 115, al-Haj (22):78; Tawbah (9): 91, Taghabun (64): 16).

[11] Narrated 'A’ishah, the wife of the Prophet, when the health of Allah's Apostle deteriorated and his condition became serious, he asked the permission of all his wives to allow him to be treated in my house, and they allowed him. He came out, supported by two men and his legs were dragging on the ground between Abbas and another man. (The sub-narrator told Ibn 'Abbas who said: Do you know who was the other man whom 'A’ishah did not mention? The sub-narrator said: No. Ibn Abbas said: It was 'Ali.) 'Aishah added: When the Prophet entered my house and his disease became aggravated, he said, "Pour on me seven water skins full of water (the tying ribbons of which had not been untied) so that I may give some advice to the people." So we made him sit in a tub belonging to Hafsah, the wife of the Prophet and started pouring water on him from those water skins till he waved us to stop. Then he went out to the people and led them in prayer and delivered a speech before them. (Sahih Bukhari, Kitab al-Tibb, Bidun Tarjemah).

[12] Ibn Hajr, Fath al-Bari, 10: 259.

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